Cost and Cost-Effectiveness in the Development of Brain Tumor Clinical Trials

INTRODUCTION: New approaches to brain tumor treatment are constantly evolving, as evidenced by the high number of completed and ongoing clinical trials. While treatment outcomes are the primary focus of such work, allocation of resources is also an important consideration in a constrained healthcare environment. METHODS: The Clinical.Trials.gov website was queried for all studies involving brain tumors that mention cost. Data on trial characteristics were analyzed to generate an overview of how cost was discussed in these studies. Data collected pertained to start date, enrollment size, study funding/sponsors, country of origin, and cost as a primary, secondary, or tertiary outcome. RESULTS: 2,572 studies were identified. Our search yielded 42 (1.63%) results that discussed cost. 27 of 42 (64.3%) studies discussed cost as being a part of the study. Of those, 2 (7.4%) has cost as a primary outcome, 19 (70.4%) has cost as a secondary outcome, and 6 (22.2%) has cost as an additional outcome. Of the 27 studies, 11 (40.7%) studies utilized a cost-effectiveness analysis as part of their design study. 11 (40.7%) studies came from drug or device trials and 7 (26.0%) studies came from procedural intervention trials. Considering evolution of cost consideration over time, 10 (37.0%) of the studies were within the last 5-year time period from 2017 - 2022, and 10 (37%) from the prior 5-year period from 2012-2017. CONCLUSIONS: Less than 1% of clinical trials pertaining to brain tumors report cost as any endpoint, despite cost being a major future consideration to implementation and use within the healthcare system. This metric has not changed within recent years, and we implore more investigators to consider and discuss cost openly to gain a more insightful economic perspective to juxtapose their proposed shift in brain tumor technologies.